Drill pin for fixation of ligaments using button/loop construct

ABSTRACT

A reconstruction system for ligament employing a button/loop construct with a drill pin. The drill pin has a shaft with a proximal and a distal end. A pin tip provided at the distal end of the shaft has a width greater than the shaft diameter. The pin tip helps cut a wider tunnel for fixation of ligaments/grafts in reconstructive surgeries. The shaft of the drill pin is provided with a laser marks for measurement of intraosseous length.

This application is a divisional of U.S. application Ser. No.12/010,537, filed on Jan. 28, 2008, now U.S. Pat. No. 8,882,833, whichclaims priority to U.S. Provisional Application Ser. No. 60/897,230,filed on Jan. 25, 2007, and which is a continuation-in-part of U.S.application Ser. No. 11/889,740, filed on Aug. 16, 2007, which claimspriority to U.S. Provisional Application Ser. No. 60/837,937, filed onAug. 16, 2006.

FIELD OF THE INVENTION

The present invention relates to the field of surgery and, moreparticularly, to a drill pin for fixation of ligaments using abutton/loop construct.

BACKGROUND OF THE INVENTION

Reconstructive surgeries, particularly anterior cruciate ligament (ACL)reconstruction, are well-known in the art. Methods of ACL reconstructionusing interference screw fixation are described, for example, in U.S.Pat. Nos. 5,211,647 and 5,320,626. In general, these methods oftenodesis involve drilling a tunnel through the tibia, drilling a closedtunnel (socket) into the femur, inserting a substitute ACL graft intothe tunnels, and securing the grafts to the walls of the tibial andfemoral tunnels using interference screws or the like.

BRIEF SUMMARY OF THE INVENTION

The present invention provides a reconstruction system for ligamentrepair. More particularly, the present invention provides a drill pinfor use with a button/loop construct for fixating a first tissue to asecond tissue (for example, soft tissue to bone, or bone to bone). Thedrill pin includes a tip that widens out to cut a wider tunnel and toallow the button/loop construct to pass through it. The drill pin isalso provided with a suture eyelet that is located at the proximal endof the pin and that captures suture attached to the button/loopconstruct. Preferably, the shaft of the drill pin is calibrated for bonedepth. For example, the drill pin may be provided with marks, such aslaser marks, to allow measurement of the distance from the femoral notchto the outer cortex, by itself or in conjunction with a depth guide, orthe intraarticular space (between tibia and femur, for example, intranstibial ACL reconstruction).

The invention also provides a method of fixating a first tissue to asecond tissue, for example, soft tissue to bone, by employing abutton/loop construct in conjunction with the drill pin, the drill pinbeing configured to lead the button/loop construct through a bonetunnel, the drill pin having a suture eyelet for capturing suturesattached to the button/loop construct. An exemplary method of ACLreconstruction using the button/loop construct in conjunction with thedrill pin includes, for example, the steps of: (i) drilling a femoraltunnel using a drill pin comprising a shaft of a first diameter, theshaft being provided with laser marks; a pin tip of a second diameterwhich is greater than the first diameter; and a eyelet; (ii) securing abutton/loop construct with an attached graft (soft tissue graft or BTBgraft) to the drill pin by passing suture from the button/loop constructthrough the eyelet in the drill pin; (iii) passing the drill pin and thesuture/button construct with the attached graft through the femoraltunnel, with sutures from the suture loop/button construct being passedthrough the eyelet of the drill pin; and (iv) securing the button to thefemoral cortex once the button exits the femoral socket.

The drill pin allows unmatched flexibility in femoral socket preparationfor ligament reconstruction and the button/loop construct facilitatesminimally invasive fixation in sockets that cannot be reached bystraight screwdrivers or crosspin guides. Additionally, the method ofligament reconstruction of the present invention provide an alternativefixation technique that simplifies measuring during transtibial drillingand eliminates overdrilling of the cortex.

Other features and advantages of the present invention will becomeapparent from the following description of the invention which refers tothe accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates a button/loop construct employing a button, accordingto the present invention;

FIG. 2 illustrates a cross-sectional view of the button/loop constructemploying the button of FIG. 1, according to an embodiment of thepresent invention;

FIGS. 3(a)-3(f) illustrate various views of the button/loop construct ofthe present invention;

FIGS. 4-9 illustrate various steps of a method of ACL reconstructionemploying the button/loop construct of the present invention, accordingto an embodiment of the present invention;

FIGS. 10 and 11 illustrate a button/loop construct of the presentinvention used for bone-to-bone (BTB) fixation, according to antherembodiment of the present invention;

FIGS. 12 and 13 illustrate an embodiment of the continuous suture loopwhich transitions from one strand to three strands;

FIGS. 14A-16 illustrate a drill pin which may be employed with thebutton/loop construct of the present invention for ligamentreconstruction;

FIGS. 17 and 18 illustrate a method of ACL reconstruction employing thebutton/loop construct and the drill pin of the present invention,according to an embodiment of the present invention;

FIGS. 19-21 illustrate a method of ACL reconstruction employing thebutton/loop construct and the drill pin of the present invention,according to another embodiment of the present invention; and

FIGS. 22-29C illustrate additional methods of ACL reconstructionemploying the button/loop construct and the drill pin of the presentinvention, according to additional embodiments of the present invention.

DETAILED DESCRIPTION OF THE INVENTION

The present invention provides a technique and reconstruction system forligament or tendon repair. The system of the present invention includesdrill pin designed for use with a button/loop construct to achievestrong fixation on cortical bone. The drill pin includes a pin tipand/or a suture eyelet. The pin tip widens out to cut a wider tunnel andto allow the button/loop construct to pass through it and the sutureeyelet is located at the proximal end of the pin to capture suturesattached to the button/loop construct.

Referring now to the drawings, where like elements are designated bylike reference numerals, FIGS. 1-3(f) illustrate a button/loop construct100 of the present invention provided with a button 10 and a continuousloop 30 attached to the button. As shown in the drawings, the button hasan oblong configuration and a width that is preferably less than about 1mm narrower than the width of the drill hole through which the button isinserted and subsequently passed through. The button is provided with aninside eyelet 20 that allows the passage of the continuous loop 30.

Preferably, button 10 has a length of about 10 mm to about 20 mm, morepreferably of about 12 mm to about 15 mm, and a width that is less thanabout 1 mm narrower than the width of the drill hole through which thebutton is inserted and subsequently passed through. Preferably, button10 is very small, having a width that allows it to pass through a 3 mmcortical pin hole without over drilling, which in turn saves time andpreserves bone. Button 10 is made of, for example, a titanium alloy.

As shown in FIGS. 1-3(f), the button 10 is provided with an insideeyelet 20 having a specific configuration that allows the passage of acontinuous loop 30, preferably a suture loop. In an exemplaryembodiment, the suture loop 30 may be a single high strength suture suchas a FiberWire® suture, sold by Arthrex, Inc. of Naples, Fla., anddescribed in U.S. Pat. No. 6,716,234, the disclosure of which isincorporated by reference herein. The continuous suture loop may beavailable in various lengths and, preferably, is the equivalent of aboutthree #5 FiberWire® suture strands, with a wide atraumatic graftinterface to protect the graft integrity.

In another exemplary embodiment, the continuous loop 30 may be formed ofa plurality of suture strands configured to separate from a singlestrand to a plurality of strands in a continuous loop. For example, thecontinuous loop 30 may include a braided strand of FiberWire® that isconfigured to trifurcate from one single strand to three strands (FIG.12). In this exemplary “three strand” design, the continuous loop isconfigured to pass through the button component at the single strandsection of the loop (FIG. 13).

The system of the present invention may be employed for fixation ofbone-to-bone (BTB), or for fixation of soft tissue to bone. In anexemplary embodiment, the button/loop construct 100 of the presentinvention is used to secure a soft tissue graft in a bone socket in aretrograde manner, for example. According to another exemplaryembodiment, the button/loop construct 100 of the present invention isused to secure a bone-to-bone (BTB) graft in a femoral tunnel or socketin a retrograde manner, for example.

In one embodiment of a method of ACL reconstruction using thebutton/loop construct 100 a femoral tunnel or socket is drilled using aretrodrill cutter which is inserted in a retrograde manner through thefemur. A graft (soft tissue graft or BTB graft) is then secured to thebutton/loop construct 100 of the present invention. Subsequently, thegraft with the button is passed through the femoral tunnel and thebutton is secured to the femoral cortex, once the button exits thefemoral socket.

The exemplary technique of ACL reconstruction detailed above is furtherdescribed below with reference to FIGS. 5-9, on soft tissue graft, andwith reference to FIGS. 10 and 11, on BTB graft.

According to one embodiment of the present invention, a femoral socketis prepared by employing a retrodrill device provided with a retrodrillcutter detachable from a retrodrill guide pin, in the manner describedin U.S. Patent Application Publication No. 2004/0199166, entitled “ACLReconstruction Technique Using Retrodrill,” the disclosure of which ishereby incorporated by reference herein in its entirety.

As described in U.S. Patent Application Publication No. 2004/0199166, aretrograde drill device for ACL reconstruction is provided with a cutterdetachable from a guide pin. The cutter is inserted in a retrogrademanner through the femur by employing a guide pin provided with depthmarkings. Once the proper anatomical position in the joint for creatinga femoral socket has been located, the marking hook of a drill guide isplaced through the antero-medial portal and inserted in an“over-the-top” position according to an outside-in technique. The guidepin is then inserted into the sleeve of the drill guide and drilledthrough the lateral femur until contact is made with a marking hook ofthe drill guide.

The cutter is then placed into the anatomical joint space through theantero-medial portal and positioned so that the guide pin can bethreaded onto the cutter. Once secured within the cutter, the guide pinis retracted in a retrograde manner until the cutter contacts thefemoral intercondylar notch. The proximal end of the guide pin iscoupled to a drill. The cutter is then rotated and retracted into thelateral femur to the proper depth as measured on the outside of the kneeby the depth markings on the guide pin. After the femoral socket isformed in this manner, the cutter is removed from the guide pin byapplying a reversed drilling motion to the guide pin while grasping thecutter.

A tibial tunnel or socket may be formed, by the method described aboveor by a conventional method, before or after the formation of thefemoral socket.

Once the femoral and tibial tunnels or sockets have been completed,graft insertion and fixation may be subsequently carried out. Accordingto an exemplary embodiment of the present invention, and as illustratedin FIGS. 4-9, graft 80 which may be a soft tissue graft is folded inhalf over the loop 30 of the button 10 and tension is applied. A sterilemarker may be employed to draw a line on the graft 80, the lineindicating a distance that equals the length of the femoral socket ortunnel plus an additional length, measured from the looped end of thegraft 80. For example, the additional length may be about 6 mm if usinga 12 mm button, or about 8 mm if using a 15 mm button. This mark will beused to indicate when the button 10 has exited the femoral tunnel orsocket.

Subsequently, passing sutures 33 are pulled and the graft 80 is passedinto the femoral tunnel or socket. When the line marked on the graft 80reaches the opening of the femoral socket or tunnel on the femoralcortex, a slight popping sensation may be felt as the button 10 exitsand begins to flip horizontally on the femoral cortex. A distal tractionon the graft 80 is applied and the passing sutures 33 are released tofacilitate complete deployment of the button 10. The passing sutures 33may be removed and tibial fixation may be completed.

FIGS. 10 and 11 illustrate a BTB graft 90 which is secured within afemoral tunnel by employing the button/loop construct 100 of the presentinvention. BTB graft 90 is secured within the femoral tunnel in a mannersimilar to that described above with reference to the soft tissue graft80. The femoral tunnel is formed preferably in a retrograde manner andthe button/loop construct 100 is also preferably inserted in aretrograde manner.

Reference is now made to FIGS. 14A-16 which illustrate a drill pin 200of the present invention and which is configured to be used with thebutton/loop construct 100 (described above) for fixating a first tissueto a second tissue (for example, soft tissue to bone). As shown in FIGS.14A-16, the drill pin 200 includes a shaft 230, a proximal end 210 and adistal end 220. A pin tip 250 is provided at the distal end 220. The pintip 250 has a width greater than the diameter of the shaft 230. Forexample, if the pin shaft diameter is 2.4 mm, which allows its use withtranstibial ACL guides and cannulated reamers, the pin tip may widen outto cut a wider tunnel, for example, a 3 mm tunnel, to allow thebutton/loop construct 100 to pass through it.

The shaft 230 of the drill pin 200 is preferably calibrated for bonedepth. In an exemplary embodiment, the shaft 230 is provided with aplurality of marks 233, preferably laser marks, for measuring thedistance from the femoral notch to the outer cortex by itself, or inconjunction with a depth guide. The marks 233 may be additionally usedto measure the intraarticular space, from tibia to femur, fortranstibial ACL reconstruction. In this manner, the marks 233 simplifymeasuring by allowing the surgeon to measure right off the drill pin 200during drilling or with the depth guide.

As illustrated in FIG. 16, drill pin 200 is also provided with a sutureeyelet 260 that is located at the proximal end 210 of the drill pin. Thesuture eyelet 260 allows sutures from the button/loop construct 100 andgraft 80, 90 attached thereto to pass through the suture eyelet 260 andthrough the knee.

TABLE 1 Drill pin Dimensions: 406 mm (overall length), 2.4 mm (diameter)Material: Stainless steel with electropolish finish; titanium alloyMarkings: Laser mark graduated laser lines along the length, allmarkings within 200 mm from the distal end Eyelet: 1.0 mm (width), 1.50mm from proximal end, 8.4 mm (length) Tip: 6.3 mm (length), 120° reliefangle for all cutting surfaces which are 180° opposed, 2.75 mm (diameterat radial relief), 3 mm (diameter at cutting edge)

Distance and depth measuring techniques using the drill pin 200described above are illustrated with reference to FIGS. 17 and 18(option 1) and FIGS. 19-21 (option 2).

Referring to FIGS. 17 and 18, the drill pin 200 is drilled through femuruntil the outer cortex is drilled, at which point a distinctive tactilesensation may be felt due to the transitioning from soft (cancellous)bone to hard (cortical) bone. When this is felt, the depth markingagainst the femoral notch (FIG. 18) is noted. In a particularlyexemplary embodiment, the marking should read about 3 cm. Subsequently,a cannulated reamer is placed over the drill pin 200 to drill thefemoral socket.

Referring to FIGS. 19-21 (option 2), the drill pin 200 is drilled untilthe “20” mark (a thick laser line) is even with the opening of thefemoral socket. A depth guide such as a Retrobutton depth guide is thenplaced over the drill pin 200 and pushed down the bone (FIG. 20). Thelength of the bone from the femoral notch to the cortex is read wherethe pin tip meets the guide. In a particularly exemplary embodiment,this length is about 32 mm.

FIGS. 22-29 illustrate additional embodiments for the preparation andmeasurement of the femoral socket using the drill pin 200 and for thepassing of a graft (such as graft 80, 90) through the tunnel with thebutton/loop construct 100 of the present invention.

Reference is now made to FIGS. 22-23C and FIGS. 24A-27C, whichillustrate two options for the formation and measurement of the femoralsocket in accordance with embodiments of the present invention: theRetroDrill™ Technique (FIGS. 22-23C) and the Transtibial FemoralPreparation (FIGS. 24A-27B). As shown in FIG. 22, a femoral guide 300 isplaced into the knee. A drill guide sleeve 301 is pushed to bone beforeretrodrilling, noting the transosseous length on the retrodrill sleeve.The drill pin 200 is then drilled into the joint and engages theretrocutter. As shown in FIG. 23B, the rubber ring 303 is set to the endof the guide sleeve 301. The socket is created by drilling on forwardand pulling the drill back, away from the bone. The depth of the socketis read by counting the 5 mm laser line marks between the guide sleeve301 and the rubber ring 303.

FIGS. 24A-27B illustrate the second option for the formation andmeasurement of the femoral socket in accordance with the presentinvention. The drill pin 200 is preloaded into a transtibial femoral ACLdrill guide by placing the end of the drill pin 200 through thecannulated tip (inset of FIG. 24). The drill pin 200 has a spade tipthat rests above the cannulation of the guide sleeve 301 (FIG. 24B). Theguide sleeve 301 is inserted into the knee through the tibial tunnel andthe tip is placed in “over the top” position. Alternatively, the guidesleeve 301 may be placed through the anteromedial portal. The drill pin200 is then advanced into the femur until the lateral cortex is felt.The intraosseous length is measured by reading the measurement on thedrill pin 200 closest to the femoral notch (FIG. 25B).

Alternatively, referring to FIG. 26A, the drill pin 200 is drilled tothe 20 mm mark and the guide sleeve 301 is placed over the tip of thedrill pin 200 and advanced to bone. The intraosseous length is measuredby reading where the tip of the drill pin 200 ends on the guide sleeve301 (FIG. 26B). A cannulated headed reamer is then placed over the drillpin 200 (FIG. 27A) and the femoral socket is drilled to a desiredlength, preferably about 30 mm (FIG. 27B).

FIGS. 28A and 28B and FIGS. 29A, 29B and 29C, illustrate the graftpassing for femoral fixation. As shown in FIG. 28A, passing sutures 33are pulled and the graft 80 is passed into the femoral socket. When theline on the graft 80 reaches the orifice of the femoral socket, a slight“popping” sensation may be felt as the button 10 exits the femoralcortex and begins to flip horizontally. A distal traction is applied onthe graft 80 and the passing sutures 33 are released to facilitatecomplete deployment of the button 10 (FIGS. 29A and 29B). The passingsutures 33 may be removed and tibial fixation completed.

Although the present invention has been described in relation toparticular embodiments thereof, many other variations and modificationsand other uses will become apparent to those skilled in the art.

What is claimed is:
 1. A drill pin, comprising: a solid shaft extendingalong a longitudinal axis between a proximal end and a distal end; aplurality of laser marks formed on an external surface of the solidshaft; a suture eyelet located at the proximal end; and a pin tiplocated at the distal end and including a width that is greater than thesolid shaft, wherein the pin tip gradually widens out and is adapted forcutting a tunnel in bone that is wider than the solid shaft, wherein thepin tip is spade-shaped, wherein the pin tip includes cutting surfacesthat are 180° opposed.
 2. The drill pin as recited in claim 1, whereinthe suture eyelet includes an elongated opening formed through theproximal end.
 3. The drill pin as recited in claim 1, wherein the drillpin is made of a metallic material and includes an electropolish finish.4. The drill pin as recited in claim 3, wherein the metallic materialincludes a stainless steel or a titanium alloy.
 5. The drill pin asrecited in claim 1, wherein the plurality of laser marks are spaced at apredetermined length from the distal end.
 6. The drill pin as recited inclaim 1, wherein the cutting surfaces each include a relief angle of120°.
 7. The drill pin as recited in claim 1, wherein a diameter of thesolid shaft is about 2.4 mm and the pin tip widens to about 3 mm.
 8. Thedrill pin as recited in claim 1, wherein the pin tip is configured toengage a drill bit that is separate from the drill pin.
 9. The drill pinas recited in claim 1, wherein the drill pin is part of a reconstructionsystem that includes a cannulated reamer.
 10. The drill pin as recitedin claim 9, wherein the cannulated reamer is receivable over the solidshaft of the drill pin.
 11. The drill pin as recited in claim 1, whereinthe pin tip includes first portions tapering outwardly from the solidshaft, second portions extending longitudinally and substantiallyparallel to the longitudinal axis, and third portions that are concaveand taper inwardly before joining together at an apex of the pin tip.12. The drill pin as recited in claim 11, wherein distal sections of thethird portions connect to the apex and are located distally of proximalsections of the third portions that connect to the second portions. 13.The drill pin as recited in claim 1, wherein each of the plurality oflaser marks are located within a distance from the distal end that isless than half of a total length of the drill pin.
 14. The drill pin asrecited in claim 1, wherein a diameter at a cutting edge of the pin tipis about 3 mm.
 15. The drill pin as recited in claim 1, wherein a lengthof the pin tip is less than about 2% of a total length of the drill pin.16. A drill pin, comprising: a solid shaft extending along alongitudinal axis between a proximal end and a distal end; a pluralityof laser marks formed on an external surface of the solid shaft; asuture eyelet located at the proximal end; and a pin tip located at thedistal end and including a width that is greater than the solid shaft,wherein the pin tip gradually widens out and is adapted for cutting atunnel in bone that is wider than the solid shaft, wherein the pin tipis spade-shaped, wherein the pin tip includes cutting surfaces that are180° opposed, wherein a length of the suture eyelet is about 2% of atotal length of the drill pin.
 17. A drill pin, comprising: a solidshaft extending along a longitudinal axis between a proximal end and adistal end; a plurality of laser marks formed on an external surface ofthe solid shaft; a suture eyelet located at the proximal end; and a pintip located at the distal end and including a width that is greater thanthe solid shaft, wherein the pin tip gradually widens out and is adaptedfor cutting a tunnel in bone that is wider than the solid shaft, whereinthe pin tip is spade-shaped, wherein the pin tip includes cuttingsurfaces that are 180° opposed, wherein the pin tip includes a firstlength that is less than a second length of the suture eyelet.